Specialty-based stereotypes are common in medicine, and they often stem from a kernel of truth. However, those stereotypes can also impact the way patients and medical students approach certain specialties.
“Stereotypes go deep in medicine….” (BMJ 1999) And so they do. Realistically, under all generalizations lies a germ of truth. But they can be exaggerated and distorted to form a caricature, a cartoon which allows us to take a cognitive shortcut. An automatic categorization frees up the time and energy it takes to get through the day. And any media attention skews our perceptions even more. Stereotypes gain a kind of currency, but docs are usually embarrassed to do more than acknowledge the differences among specialties in passing. But we can learn something if we suck it up and take a minute out to think about it, and us.
Let’s start with some humor, with a barb, that contains the above mentioned germ:
“How can you hide a dollar from an orthopedist?” — “Put it in the chart.”
“How can you hide a dollar from a radiologist?” — “Put it on the patient.”
And “How can you hide a dollar from a plastic surgeon?” — “You can’t….” Ouch!
Docs are a competitive and chauvinistic breed. We love to needle and we have a culture of complaining that predates EHR and ICD-10, don’t you know. And whatever our specialty, we somehow feel the truth of these characterizations apply a little bit to all of us. So we feel a minor relief if the finger is temporarily pointed at another, brother guild. “I’m ok because that other doc in that other specialty has X characteristic worse than I do.” And these perceptions take root because docs rarely switch specialties.
The power of these stereotypes is perhaps felt most keenly in the medical student’s world when sorting through future options. I found two studies that said 1.3% and 3.9% of career choices respectively were negatively affected when exposed to a list of exaggerated specialty characteristics. We do, for better or worse, self-diagnose and try to match ourselves to how we perceive a particular discipline’s characteristics.
But we know from personal experience our choices in this matter are not that simple. Exposure to a particular attending or senior resident can push us either positively or negatively in regard to that specialty. Or the perceived respect among attendings can subtly influence our leanings. Role models matter a lot in medicine.
There is much flexibility in medical careers and what we do with, and within, them is noticed. E.G. - The “mind versus the body,” “cognitive versus procedural,” “thinkers versus doers,” to oversimplify. And the irrational skews built into remuneration among the specialties is important and it too is noticed. All too often, some young doc’s choices, especially in this era of oversized student debt, “follow the money,” as was made famous in the Watergate saga.
But the times are changing, in an unprecedented way. Firstly, there is a seismic gender shift underway which will no doubt ingrain itself into our perceptions over time and shift them. Sixty percent of all medical students are now women.
The historically uneven advance of technology will also generate changes in our view of specialty comparisons. Some specialties will rise in other’s estimations, temporarily, until advances boost other specialties in turn into the limelight. New tech in a given field has in the past often led to more respect and, of course, more money. So our future characterizations of specialty difference will be altered.
Other than the above joke, I am not going to get into a current laundry list of the stereotypic tendencies that characterize each specialty. I will leave it to you, dear reader, to sit back, reflect on your own experiences, and muse on the mud.